An Unorthodox Approach To Tricky Surgery

Striking a pose like Hamlet, Kofi Boahene, a surgeon at Johns Hopkins Hospital, peers through the natural opening under the cheekbone and above the jaw that he uses for surgery.

Keith WellerCourtesy of Johns Hopkins Medicine

Add minimally invasive surgery through an opening between the cheek and jaw to the list of procedures I'm happy exist and that I hope I'll never have to endure.

A Johns Hopkins surgeon who is pretty handy with an endoscope has figured out how to operate in some hard-to-reach spots at the base of the skull through a natural opening that's above the jawbone, behind the back teeth and just below the cheekbone.

It requires a small incision inside the cheek, sure, but that's no biggie, really.

Dr. Kofi Boahene, an assistant professor of facial plastic and reconstructive surgery at Hopkins, has tried the technique in a handful of patients. The results from four cases were described in the journal The Laryngoscope last month.

The base of the skull is a tough place for an operation because of all the nerves and blood vessels there. The usual approach to removing tumors or dealing with other problems in the infratemporal fossa and parapharyngeal space, if you're interested in the particulars, is invasive and can be disfiguring.

The new, endoscopic technique seems pretty slick but also a little tricky. Can other surgeons do it? I emailed Boahene about that. He replied: "The procedure can be widely done. I have already taught another surgeon in another hospital who has done one case."

So far the patients have fared well. One patient had temporary trouble swallowing after the operation, another had some numbness in the lower lip that soon went away, the recently published paper says. The other two patients had no reported complications.

Next month, the approach will be taught to more surgeons at a Hopkins conference. "The surgical skill set required for this can be made widely available quickly," Boahene wrote. His peers already have the equipment and comfortable using it, he added.

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